DILIS Devon Independent Living Integrated Service

DILIS Devon Independent Living Integrated Service Preparing a tender for a new Service Provider 7 th November 2013 Healthwatch Devon Experts Panel c/o Community Council of Devon 3 & 4 Cranmere Court, Lustleigh Close Matford Business Park, Exeter EX2 8PW Contact: Greg Davies greg@devonrcc.org.uk 01392 248919 x 181

What is the Experts Panel? The Experts Panel is a group of people representative of the general public who have expertise by virtue of their 'lived experience' of using health and social care services in Devon. They are recruited from a range of organisations that are part of the Healthwatch Devon partnership. What are the aims of the Experts Panel? The Expert Panel aims to: Have a voice in improving current services and shaping services for the future Provide expert challenge and support to service commissioners and providers. Have input in any future changes within Devon County Council and NHS Devon by providing views which will be heard at a strategic level Give feedback on the work of the Panel to the Joint Engagement Board What does the Experts Panel do? The Expert Panel provides an opportunity for people who use services and their carers to share their lived experience with project officers with particular focus on changes in health and social care by Devon County Council and NHS Devon. People are experts because they are at the receiving end of services and give a different but essential view of proposals to any change in services. 1

Issue: Devon Independent Living Integrated Service (DILIS) Expert Panel Scenarios November 2013 Devon County Council is looking for a supplier to provide an Independent Living Service, including Equipment, Minor Adaptations and Telecare to users across Devon. To help them select a supplier the County Council will ask them to look at a made up case and say how they would deal with it. The case below will hopefully allow suppliers to explain what range of equipment and support they would provide. Can the Experts Panel suggest any changes to the case below that would help Devon County Council get a better idea of the suppliers suitability to provide the Independent Living Service, including Equipment, Minor Adaptations and Telecare. Case Scenario : Part 1 Martin James is 34 years old. He has a learning disability which impacts on his ability to communicate verbally. He uses sign language (Makaton) to communicate with his friends and family. He has little awareness of danger. He is at risk when out in the community crossing roads and frequently gets lost when trying to find his way around if he is alone. He also suffers from epilepsy as a result of a head injury when he was 5 years old. He currently lives with his elderly mother in a small cottage on a steep hill in a rural and isolated village in North Devon. He has recently expressed a wish to live independently of his mother. He is being helped to explore having his own property in his local area, with the expectation there would be support to help him. He wants to be able to meet his friends, to play pool at the local pub and to be able to do his own food shopping. Part 2 His mother has recently suffered a stroke and was admitted to Derriford Hospital in Plymouth. The stroke has left her with a right sided weakness affecting her mobility. She is due to be discharged home the day after tomorrow. Following an assessment by the hospital Occupational Therapist, various items of equipment have been identified as essential for her to be discharged and be safe at home. Grab rails: at the front door and installation of a second banister rail Chair raisers/bed raisers Raised WC seat and floor fixed WC frame Perching stool for the kitchen Further equipment is required longer term: A powered bath lift Rails along steep steps to footpath In addition Mrs James would be happy to consider buying some equipment that is not FACS (Fair Access to Care) eligible as she knows it will improve her ability to support herself and Martin: Small equipment to support her to complete kitchen tasks (eg. non-slip matting, peelers, breadboard, carving knife etc) 2

Response: General Comments: The Panel made some general comments before considering the scenarios provided: 1. Big is not always beautiful rolling everything together into one contract might exclude some smaller providers, but larger providers don t always give the best service. They can be more remote or not have an understanding of the clients and not provide the best customer service. 2. A decision to bring all the services together under one provider should be in the best interests of the clients and not for political or purely financial reasons. 3. It is important that in changing to a new contract the chosen provider addresses the problems of delays currently experienced (an example given was of the time taken to replace equipment for people with a visual impairment. 4. Items that are needed immediately by clients should be available quickly and where repairs or replacements are needed these should also be handled promptly (eg a broken White Stick) 5. Thought needs to be given to out of hours and weekend provision. Concern that reliance may be placed on volunteers. 6. As part of the selection process will potential providers be required to show evidence of the things they have previously done? 7. An online / email progress update service would be useful to some clients 8. Part of the current delays are about where stocks of equipment are held. Potential providers should specify where they will hold stocks (Bristol is not in Devon). 9. Service users (eg members from the Experts Panel) could be used in the selection process, perhaps sitting on selection panels. Some of the panel have previous experience of this. Scenario Part 1: 1. It is difficult to see these as two separate cases are the people described are a mother and son. 2. Will providers recognise that making it possible for Martin to live away from his mum will leave her more isolated? 3. There are many examples where people are in mutually caring situations (where two people provide some care for each other). This is particularly common in rural areas where transport is poor. Will providers recognise this? 3

4. The way the story is written some of the panel had different views of where Martin wanted to be. What does in his local area mean? 5. The scenario does not address housing which is often seen as a separate issue from health and care. But in reality they are often closely linked. 6. In the scenario, if Martin s mum died what would be Martin s situation? 7. The importance of transport in rural areas is not addressed by this scenario, presumably because it is not part of the services being tendered for. 8. Having identified Martin s needs, is there a budget to provide the equipment? 9. Some options might be; Personal Independence Payments, short term equipment loan schemes, a sort of try before you buy or sale or return scheme might actually save on costs in the long run with people not having equipment which they do not find useful. 10. If clients want equipment that the service cannot fund there are opportunities to share the cost a top up system, or for the client to meet the full cost. They would still be able to get some advice and support. Scenario Part 2: 1. Is there some confusion about the roles of the service provider and the OT assessor? Most of the decisions are not made by the service provider. 2. How quickly equipment is available is very important. Where it is physically held in store will determine how quickly it can be delivered. 3. Any delays with hospital discharge is unwelcome. It leads to bed blocking and inappropriate discharge. Patients may then go home, not be properly supported and have to be re-admitted. 4. Most of this scenario is about equipment that you would expect to be provided from one source and probably all together. To test whether potential providers are aware of the range of services that might be required the need for Telecare could be added in. Providers would then be expected to say how they would ensure everything was available for the patients discharge. 5. You could also add in the need for minor adaptations not just equipment. 6. Would you expect service providers to talk about doing a home visit before the patient is discharged? 7. It is not just about the systems a potential provider has, it is also about the people. What are the skills of the delivery staff who will actually need to deal directly with clients. Do they have the necessary communications skills (eg in Martin s case Makaton). 8. Clients will often need information about the service or equipment being provided. Will this be provided in an appropriate format for the particular individual (eg a written guide is not very useful for someone who is blind). 9. Will the potential provider be able to work with the clients and the OT. Listening to both, helping to make good decisions 4

Burning Questions: The Panel was asked what questions the potential providers should be asked at an interview: 1. Reliability of equipment and the service would the correct equipment (what had been requested) be delivered? Would it be of a suitable quality? Would it be provided on time, when it is needed? 2. Staff Will the right staff, with the right skills and training be available when and where necessary. Will they have good interpersonal skills, understand their business and give good customer service? 3. Communication Will the providers recognise that different people require different types of communication? Will they know that individuals often have more than one particular need and be sensitive to this? Will they offer and support a range of communications options eg phone, written, audio, email etc? Closing Thoughts: 1. In the first instance clients should be able to contact the service provider direct if there are any problems. In that way they may get a quicker and better service. There will not be an intermediary adding delays and possibly confusing the message. Providers would be more responsible for resolving any problems and be able to use the queries in order to improve the quality of their service. 2. Post contract award monitoring how will the provider be monitored? As well as the formal contract monitoring it is expected that providers will do some self assessment based on client feedback. They should also have an appropriate complaints procedure. OTs are encouraged to give feedback. Clients views should also be sought. Are they satisfied with the service? 5